Health Systems in Transition - Hungary - World Health Organization ...

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32 Health systems in transition Hungary the Hungarian State Railways, has its own comprehensive system of health service delivery within which railway workers and their dependants are given priority (1994/3). The number of providers and their capacities, however, were significantly reduced in 2007 (2007/4). The Ministry of Defence has its own inpatient and outpatient services, which are open to the general public, although special rules give priority to its employees. According to the general principles applied in health care financing, both ministries cover the capital costs of services, whereas recurrent costs are financed through the HIF. The Ministry of Public Administration and Justice provides health services to prisoners; this is entirely separate from the main system of provision. Finally, the Ministry of the Interior deals with issues for local governments, which are the owners of most primary and secondary care facilities. Among other duties, the Ministry administers the allocation of capital grants for health care equipment and buildings to local governments (1992/9). 2.3.7 HIF and the NHIFA The HIF is the most important financing agent for the recurrent costs of health services, and finances certain cash benefits, such as sick pay. The HIF is separate from the government budget in so far as any surplus it generates cannot be used by the government for other purposes. The government is obliged to cover any shortfall in the HIF (1997/8), and shortfalls in the HIF appear in the government budget deficit. The HIF is divided into more than 30 sub-budgets according to type of service (e.g. acute inpatient care, chronic inpatient care and outpatient specialist care). Most of these sub-budgets are capped, and the provider payment mechanisms help to ensure that the caps are, in fact, observed. The NHIFA is a government office and thus under the direct control of the state. It administers the HIF and is the sole payer in the Hungarian health insurance system. It has no discretion over revenue collection or budget setting, however, and has only very limited discretion over purchasing decisions (see sections 2.3.2 and 3.4.3). The NHIFA has territorial units and subunits at the regional and county levels, respectively. These units manage administrative work and other tasks delegated by the NHIFA central office, but have no autonomy in contracting and paying local health providers. Moreover, the budget of the NHIFA has remained centralized since its inception.
Health systems in transition Hungary 33 HIF contributions are not collected by the NHIFA but by the Tax Office. The responsibility for administering cash benefits financed through the HIF lies with the Ministry of Public Administration and Justice, although various details of the benefits are determined by the NHIFA and Ministry of National Resources. 2.3.8 Professional Colleges and the National Institutes of Health Various institutes and professional bodies assist the State Secretariat for Healthcare. Some of them, such as the professional colleges (Szakmai Kollégiumok) and the National Institutes of Health, provide expert input on particular medical specialties (1989/2, 1999/11, 2008/6), while others, such as the Health Care Scientific Council (1989/3, 2003/3) or the Health Care Professional Training and Continuing Education Council (1998/21, 2010/1), deal with more general areas, including science and policy issues or education. The members of the professional colleges consist of the leading consultants from particular medical specialties, and are elected by delegates from the Hungarian Medical Chamber, medical schools and the relevant scientific associations. Currently there are 49 professional colleges for specialists in fields ranging from internal medicine to neurosurgery and health informatics, and for pharmacists and nurses (1999/11, 2008/6). The National Institutes of Health are the centres of excellence for particular medical specialties (1997/20). They supervise and support clinical work across the country, provide continuing education, conduct scientific research, and in certain cases engage in prevention activities and provide patient care, especially highly specialized, tertiary care services for the entire population. The National Institutes of Health issue clinical guidelines, setting out protocols and standards, and some are attached to university departments. Their clinical work is financed by the HIF, whereas their other activities are covered by the central government. Some of the National Institutes carry out special administrative duties. For instance, the Information Centre for Health Care – a department of the NHIFA since 2004 – runs a system of provider output reports, which are used as the basis for determining hospital payment (1987/1) (for details see section 3.7.1). Another example is the National Institute for Strategic Health Research (NISHR), which is the policy research institute of the State Secretariat for Healthcare and was created, in part, from the National Institute and Library for Health Information (MEDINFO), and has conducted policy research in
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Health Systems in Transition Vol. 1
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Health Systems in Transition Péter
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Contents Preface
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Preface The Health Systems in Trans
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Acknowledgements The Health System
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Page 19 and 20: Abstract Hungary has achieved a suc
Page 21 and 22: Executive summary Introduction Hung
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Page 31 and 32: 1. Introduction 1.1 Geography and s
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4. Physical and human resources 4.1
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5. Provision of services Health car
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6. Principal health reforms 6.1 Ana
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8. Conclusions Since the mid-1990s,
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The Health Systems in Transition pr
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The European Observatory on Health
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